Laserfiche WebLink
CITY OF ORONO <br /> BUILDING PERMIT APPLICATION <br /> FOR NEW STRUCTURES OR ADDITIONS <br /> � Mailing Address: Permit number: �� � "n/ � <br /> �y- �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � Z /z z-�( <br /> _�_._, _ • . <br /> L-1�� <br /> StreetAddress:' ' -�"�- <br /> � __ ...._..... <br /> y� G��'' 2750 Kelley Park ay �C''�L Zj(�� an review fee: I �l . � � <br /> 1 �, Orono, MN 55356 � " <br /> '�x�sHo� . �D�S <br /> Total Fee: j' �/�—7 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us / <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: ��j�j n C_ ^�5.��� �^ � ���� <br /> Job Site Address: ��J� U `-�'r� �� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes ❑ No <br /> If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitfed events will not be allowed. <br /> CONTRACTOR/APPLICANT INFOR ION�. <br /> Name: CLI� (,l i l�e.� C� <br /> State License# Expiration Date: � c�t�/ <br /> Phone: cell a-3i�3 - �i6 office �� - 3 �� � <br /> MailingAddress: f` E c(L _ �Y.e� � t�,, Cit : � �_ ZIP: �� .,� <br /> Contact Person: �� s'c �� e Applicant is: ontractor / Homeowner (CircleOne) <br /> Email and/or Fax: — � i.U�r� ct �_ �Li ��.Q. � <br /> PROPERTY OWNER INFOR A 10 . � n <br /> Name: U-( �G�E�'2S � <br /> Phone (day): a-- ��( S— 1�S � _ �`� I(�J r / c..� <br /> Address: '� `Q� - � Cit : ��nl���/i�-��C�2ZIP: �� (� <br /> Email and/or Fax -f���� c�c� u � �uc l �p,e. . <br /> ARCHITECT!ENGINEER INFORMATION: f y� <br /> Name: --� �,t.1( �l..t.d�--- <br /> Phone (day): �a- -3 �� r ��( � <br /> Address: 'u.L; � - .f,% -2i�/'� � Cit : �l �'Vl►� ' IP: ��3�� <br /> Email and/or Fax: 1'yl �- oc>cQ � <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3.Struct re Type 4.Sewage Disposal & <br /> Wate Supply <br /> New Construction ingle Family with Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation detached garage ❑ Office/Commercial ❑ Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage Public Water <br /> **Any earth movement may also require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven,MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ ��D��� <br />